Kelly A. Lively, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT00693 Issued in RI

Practice address

1180 Hope St
Bristol, RI 02809-1126

Phone

(401) 254-1105

Fax

(401) 254-1026

NPI assigned

Jul 2, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kelly Tuccilo Former name

Medicare fee-for-service enrollment

Enrolled in VT

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pinnacle Physical Therapy, Inc

  • Physical Therapist
  • Stowe, VT
  • NPI 1912053554
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214956800000",
    "number": "1417119249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 20372",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029200944",
            "telephone_number": "401-785-1016",
            "fax_number": "401-785-1018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1180 HOPE ST",
            "city": "BRISTOL",
            "state": "RI",
            "postal_code": "028091126",
            "telephone_number": "401-254-1105",
            "fax_number": "401-254-1026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIVELY",
        "first_name": "KELLY",
        "middle_name": "A.",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-02",
        "last_updated": "2008-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "RI",
            "license": "PT00693",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PT 00693",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "TUCCILO",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• John Labao
• Sarah Elizabeth Flinn Larson, MS, RD, LDN
• Lepre Physical Therapy of Bristol, LLC
• Susan Helen Levesque-Degrazia, RPH
• Sulwa Lima
• Living in Fulfilling Environments, Inc.
• Living in Fulfilling Environments, Inc.
• Living in Fulfilling Environments, Inc.
• Looking Upwards, Inc
• Kathryn G Low, PH.D.

• Physical Therapist in Bristol, RI
• Providers in Bristol, RI by specialty
• Physical Therapist in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.